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June 4, 2003

Variation in Use of Broad-Spectrum Antibiotics for Acute Respiratory Tract Infection—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(21):2796-2798. doi:10.1001/jama.289.21.2796-a

To the Editor: Dr Steinman and colleagues1 found that broad-spectrum antibiotics are commonly prescribed in the United States for the treatment of acute respiratory tract infections (ARTIs), especially by internists and physicians in the Northeast and the South. However, several confounding factors may bias the results toward the overuse of broad-spectrum antibiotics. First, the authors did not report failure rates after completion of a course of a first-line narrow-spectrum agent, which would have resulted in treatment with a broad-spectrum agent. Second, the authors did not assess other clinical aspects that may have warranted appropriate use of a broad-spectrum antibiotic. For example, patients who were previously treated for the same respiratory tract infection within the past 6 months have been found to have a higher prevalence of resistant organisms.2 Smoking, which increases the likelihood or resistant organisms, is also important.2 Finally, the authors did not clearly identify the "predictors" of broad-spectrum antibiotic prescribing for ARTI. With sinusitis, bronchitis, and otitis media accounting for 75% of antibiotic prescriptions in the United States and with the most common associated pathogens being Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis,3 appropriate use of antibiotics and the clinical reasons for prescribing them are important.

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